Newborn circumcision: a risk-benefit analysis revisited.

Recently a study published in the Canadian Journal of Urology in which a group of scholars including Dr. Pollock offer a different view of circumcision based upon the most recent evidence. The National Post subsequently published an article on this story which we post below for you to read at your convenience:

Sharon Kirkey | October 13, 2016

The Canadian Paediatric Society’s position that the benefits of removing a baby’s foreskin do not outweigh the risks is based on “sloppy scholarship” and inflated harms, argue the authors of a new review recommending circumcision for all newborn boys. They say the pediatric society’s stance should be revised so that it’s more in line with the American Academy of Pediatrics, whose latest policy concludes that the scientific research shows clearer health benefits to the procedure than had previously been believed, including a lower risk of acquiring HIV, genital herpes, the human papilloma virus (HPV) and syphilis.

Although the Americans said the health benefits aren’t great enough to recommend routine circumcision, “the benefits are sufficient to justify access to this procedure for families choosing it” and that insurers should pay for it.

“There’s a lot of hysterical nonsense by the anti-circumcision movement that is really like the anti-vaccination movement, and it’s appalling when a body like the Canadian Paediatric Society can fall for this nonsense,” said lead author Brian Morris, a professor emeritus in the University of Sydney’s school of medical sciences.

“They’ve got to really step back and look at the hard scientific evidence, and the scientific evidence is unequivocal in showing that male circumcision, especially performed in infancy, has enormous benefits,” said Morris, whose co-authors include B.C.’s Dr. Neil Pollock, creator of the Pollock Technique™, which promises parents “virtually painless,” 60-second circumcisions for $445, for babies aged two months and younger.

Their review is published in the most recent issue of the Canadian Journal of Urology.

Studies have also shown a lower risk of urinary tract infections among circumcised versus uncircumcised boys, and a lower lifetime risk of penile cancer. The operation has also been linked to a reduced risk of prostate cancer among black men.

When added up, “we found that up to 65 per cent of uncircumcised males might experience at least one of these (medical conditions) over their lifetime,” according to the authors, who conducted a new risk-benefit analysis of the controversial procedure and conclude the benefits exceed risks by about 100 to one.

The Canadian Paediatric Society has long held that circumcision’s risks — including pain to a small baby, bleeding, infection, an “unsatisfactory cosmetic result,” and, in rare cases, partial amputation of the penis and death from hemorrhage or sepsis — outweigh its benefits.

The group revisited the issue last year with an updated position statement. The new policy acknowledges that growing evidence suggests circumcised boys are less likely to suffer urinary tract infections and penile cancer, and that their female sexual partners are less likely to contract several sexually transmitted infections or cervical cancer.

However, while circumcision may benefit boys in “high-risk populations,” the society still does not recommend the routine circumcision of every newborn male, arguing the risk-benefit ratio is too “closely balanced” to make “definitive recommendations for the entire male newborn population in Canada.”

The society cited one study that found a complication rate of 1.5 per cent.

However, Morris, whose team conducted their own risk-benefit analysis, said the society’s policy was based on weak studies that over-called the harms and under-estimated the benefits.

Morris said his team’s analysis estimates the combined frequency of adverse events is 0.4 per cent, overall, and that “the cumulative frequency of medical conditions attributable to (having an intact foreskin) was approximately 100-fold higher” than the cumulative risks of circumcision.

The authors say newborn circumcision is “convenient, quick, safe, low-cost and provides immediate and life-long protections” but that, if done later in life, “takes longer, costs more and includes a 10 to 20 fold higher risk of adverse events.”

Circumcision rates have been falling in the past few decades in Canada; a trend the pediatric society says has been “significantly influenced” by its past recommendations.

According to the pediatric society, most Canadian boys were circumcised in the middle of the last century. But the rate has fallen over time, and now sits nationally at about 32 per cent. In the U.S., rates are increasing, to 61 per cent.

The group says parents should receive “the most up-to-date” and unbiased information about newborn circumcision so they can weigh the risks and benefits in the context of their own personal, religious and cultural beliefs.

Morris agrees that the decision should ultimately be left to parents.

“Some parents, no matter what, will decide not to vaccinate their children. That’s their choice,” he said.

“But it’s crucial they receive proper information — accurate, scientific information, so they can make an informed decision.”

“And that has to happen early in pregnancy, or very soon after the birth of the child if it’s a boy.”

In a related commentary, Dr. Armando Lorenzo, a pediatric urologist with Toronto’s Hospital for Sick Children, says circumcision not only permanently alters a part of the male anatomy, “it is performed without the consent and understanding of the affected individual, the newborn boy.”

The procedure can also bring a false sense of security, “triggering a more relaxed attitude towards risky behaviours” and, paradoxically, he said, increasing the risk of STDs.

A spokesperson from the Canadian pediatric society was unavailable for comment Thursday.